Ramappa Preeti, Thatai Deepak, Coplin William, Gellman Steven, Carhuapoma J Ricardo, Quah Ruth, Atkinson Benjamin, Marsh James D
Division of Cardiology, Harper University Hospital, Wayne State University, 1 Webber South, 3990, John R. Street, Detroit, MI 48201, USA.
Neurocrit Care. 2008;8(3):398-403. doi: 10.1007/s12028-007-9038-7.
Release of cardiac biomarkers is reported in patients with subarachnoid hemorrhage (SAH). Data addressing the impact of cardiac injury on outcome in these patients is sparse. This study was conducted to ascertain the association of elevation of serum cardiac Troponin-I (cTnI) with mortality and neurological outcome in patients with SAH.
Medical records of all patients admitted with a diagnosis of SAH and at least one measured cTnI were reviewed. Demographic and clinical variables including admission neurological status were collected. Conservative and non-parametric statistics were used to assess association between cTnI and death or neurological outcome at discharge.
The study group comprised of 83 patients with a mean age of 59 years. There was a female (60%) and African-American (60%) preponderance. At admission, the median Glasgow Coma Scale (GCS) was 9, and 47% had a severe Hunt-Hess grade (HHG) of > or =4. Elevation of cTnI was found in 31 (37%) patients and was associated with worse baseline Fisher grade (p=0.01) and neurological status: GCS score (p=0.006) and HHG (p=0.007). Patients with abnormal cTnI were more likely to die (55% vs.27%; odds ratio 1.3-8.4, p = 0.01) and had a worse GCS score (p = 0.008) and HHG (p = 0.004) on discharge. On multivariate analysis, peak cTnI (p = 0.04) and admission GCS score of <12 (p = 0.02) were independent predictors of death at discharge.
Patients with subarachnoid hemorrhage and elevated cTnI are found to have worse neurological status at admission. These patients have a worse neurological outcome and in-hospital mortality.
蛛网膜下腔出血（SAH）患者中存在心脏生物标志物释放的情况。关于心脏损伤对这些患者预后影响的数据较少。本研究旨在确定血清心肌肌钙蛋白I（cTnI）升高与SAH患者死亡率及神经功能结局之间的关联。
回顾了所有诊断为SAH且至少测量过一次cTnI的患者的病历。收集了人口统计学和临床变量，包括入院时的神经状态。采用保守和非参数统计方法评估cTnI与出院时死亡或神经功能结局之间的关联。
研究组包括83例患者，平均年龄59岁。女性（60%）和非裔美国人（60%）占多数。入院时，格拉斯哥昏迷量表（GCS）中位数为9分，47%的患者Hunt-Hess分级（HHG）为≥4级，属于重度。31例（37%）患者cTnI升高，且与较差的基线Fisher分级（p = 0.01）及神经状态相关：GCS评分（p = 0.006）和HHG（p = 0.007）。cTnI异常的患者死亡可能性更大（55%对27%；比值比1.3 - 8.4，p = 0.01），出院时GCS评分（p = 0.008）和HHG（p = 0.004）更差。多因素分析显示，cTnI峰值（p = 0.04）和入院时GCS评分<12分（p = 0.02）是出院时死亡的独立预测因素。
蛛网膜下腔出血且cTnI升高的患者入院时神经状态较差。这些患者神经功能结局和院内死亡率更差。
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